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r .a k,,,,, `\ Agricultural or Forestry Building Exemption Certification � 1J'� Marion Equine Facility Exemption Certification Z 7 ��//2/� 1" County Public Works—Building Inspection Division arion �� Counc,,y 5155 Silverton Rd.NE, Salem Oregon 97305 Phone: (503) 588-5147 Fax: (503) 588-7948 Email: building@co.marion.or.us O R EGO N Site Plan is Required—see attached information Owner/applicant name: Hazenberg Dairy Phone: 503-899-0094 Email: conorjhaze@hotmail.com Mailing address: 5828;hampoeg RD NE City t e: S).. Paul, OR Zip: 97137 Job site address C—hampueg-RB-NE,5 �/7iyf`ifate fit. Paul, OR Zip: 97137 61 ,4 ' �t�o 1� Parcel Informn: Parcel Size: 9.� L.5 � Parcel'No.: 1(� `�o c.)( f y o(> Zone: Proposed Building Information Describe specific use of the building and items contained within Cow barn for cows. Building Data: Length: QC)Li Width: 12'�i Area: 'L5I V�2 � _ Height: 1 b' Type of Exemption: I Agricultural Building ❑Forestry Building ❑Equine Facility(Provide information below): What is the proposed maximum number of people(including employees, owners,etc.) that will be present in the building at any one time? 4 g7 1 Will this structure be used by the public at any time? ❑Yes IN No vrol ir ',i`�i�! I 0 Is the proposed structure located within a floodplain? ❑Yes IN No .u 1 Is the building located on/used in the operation of a farm? UYes ❑No Is the proposed structure a residential dwelling or manufactured home? ❑Yes PI No Is the use of the structure or the items within it used for any business or commercial activities? ❑Yes PI No If yes,please explain: Agricultural/Equine Exemption Criteria—Select all that apply: ❑ Storage,maintenance, or repair of machinery, equipment, and supplies used on this farm ❑ Raising,harvesting, or selling crops raised on this farm I Feeding,breeding,management, or sale of livestock,poultry, forbearing animals, or honeybees I Dairying or the sale of dairy products produced on this farm ❑ Other agricultural,horticultural, or animal husbandry used ❑ Stabling,training,riding lessons, or clinics (Complete Equine Exemption Criteria) #of stalls/horses #of stalls/horses for personal use only #of stalls/horses used for commercial or trade purposes including boarding,training,rentals, clinics, shows, etc. Which of the following systems will the proposed structure have? Electrical •Yes ❑No (Complete Electrical Wiring Criteria) Will there be a concrete slab either within or adjacent to the building? 'Yes ❑No Will there be farm animals (poultry excluded)within the building at any time? PYes ❑No Will there be farm animals(poultry excluded)on the slab at any time? es Will the building be used for storage of feed,hay, or straw? ❑Yes P o Will the building be used for major repair of motor vehicle equipment? ❑Yes IN No Heating/cooling/ventilation/mechanical ❑Yes IP No Septic ❑Yes INo (Any yes answer will require a separate permit) Plumbing(Please specify fixture type) ❑Yes I No Page 1 of 5